Medic One A Critical Link In Our Chain Of Survival

Medic One!

We go for the best we can!

We reach with our hearts!

Your destiny is in our hands!

We give our most, our best, our brightest light!

We are Medic One!

THE above words were written and movingly sung by 12-year old Kendra Eades at a banquet in October celebrating the 20th anniversary of King County's emergency medical services system (EMS.) Kendra, now a healthy, tall, bright and lovely girl, almost died six years ago.

When she was 5, Kendra was visiting her grandparents in Renton. While running outside, she crashed though a glass storm door, and a 4-inch piece of glass deeply penetrated her chest and her heart. At first dazed, Kendra quickly fell unconscious and unresponsive. Blood spurted from her wound. Fighting fear, her grandfather, having taken CPR classes, immediately initiated resuscitation, while her grandmother called 911.

The 911 operator swiftly assured that effective CPR had been started and dispatched Renton Fire Department firefighters - trained as emergency medical technicians - who quickly arrived, took over CPR and started additional basic life-support measures.

Minutes later, paramedics arrived from the county's Medic One station in Kent, and advanced life-support measures were immediately added. Paramedics, with extensive advanced training, intubated Kendra, added fluids in IV lines to restore blood volume, and administered drugs to revive her heart. Kendra's pulse and blood

pressure were restored, and paramedics rushed her to a nearby landing zone, where she was loaded onto a helicopter for a fast flight to Harborview Medical Center.

En route to Harborview, Kendra's heart stopped, but the trained nurses aboard resuscitated her. In the emergency room, her heart stopped again, but again she was brought back to life. She was immediately wheeled into an operating room, where a large piece of glass was removed from her heart.

Thereafter, she was transferred to Children's Hospital, where additional open-heart surgery was performed. Kendra recovered successfully, and as her song testifies, she and her family continue to express appreciation to the people in the emergency medical system who saved her life.

Kendra's wounds were so severe, she probably would not have survived in many other regions of the country. But her survival in King County was no accident - our EMS system saves children like Kendra and thousands of other county residents every year.

Created in Seattle in 1969 and initially paid for with bake sales, grants and donations, the Seattle-King County emergency medical system has grown into a seamless regional partnership of 35 fire departments, five paramedic providers, cities, the county, the University of Washington, Airlift Northwest, and private ambulance companies. This extraordinary system is due to the early vision of emergency physicians, elected officials, fire chiefs and other community leaders, and the support of voters who approved the first six-year levy in 1979.

Since then, the EMS system pioneered in Seattle and King County has become famous around the world. The expression that "Seattle is the best place in the world to have a heart attack" was coined after a 1974 "60 Minutes" story about the early years of the paramedic program. No other emergency medical system maintains a better survival rate for out-of-hospital heart attacks. All this at a reasonable cost - other communities in this region pay more for less comprehensive service.

The success of our EMS system is based on a "chain of survival" - each link in the chain is an essential element of a tiered coordinated system involving many agencies and providers protecting all areas of King County.

-- The first link in the county's emergency medical system is citizen-initiated CPR. Kendra's grandfather had taken CPR classes and was able to initiate the first important step to saving his granddaughter's life.

-- The 911 telephone system is the next critical link. Kendra's grandmother called 911, which triggered the activation of the emergency response system.

-- Basic life support is the next link - as the first responders to the scene, firefighters trained as emergency medical technicians based at 35 fire departments around the county arrive within 4-6 minutes of dispatch by 911. They responded to more than 133,000 emergency calls in 1996, and this number is growing 6 percent annually. The Renton Fire Department quickly dispatched a fire truck and aid car when Kendra's grandmother called 911.

-- Advanced life support is the next link. ALS is performed by Harborview-trained paramedics operating from five paramedic provider agencies around the county - Seattle Fire Department, Shoreline Fire Department, Evergreen Medic One, Bellevue Medic One, and King County Medic One. Paramedics are dispatched when medical emergencies are urgent or life threatening, generally arriving at the scene within 10 minutes of dispatch by 911. They responded to more than 46,000 calls in 1996. King County Medic One paramedics Tom Gudmestad and Mel McClure helped Renton firefighters save Kendra with aggressive trauma resuscitation and rushed her to meet the Airlift Northwest helicopter, which flew her to Harborview.

-- The hospital and medical care systems comprise the last links in this chain of survival. In Kendra's case, the other links in the chain of survival kept her alive until trauma surgeons and nurses could complete the job of saving her.

Every one of these interdependent links - taken together - form the chain of survival that the Seattle-King County area has been so proud of. If any link is weak, survival rates will be poor.

The EMS levy vote last November demonstrated that almost 57 percent of King County's voters supported continued funding of this critical service; unfortunately, this was not the 60 percent required to maintain our current regional funding approach that supports this chain of survival.

To address this crisis, our elected officials are developing short- and long-term EMS funding solutions, including a new levy vote in February. As the public health official responsible for our county's EMS services, and as co-chair of the Regional EMS Strategic Planning Committee, I want to emphasize that we must maintain the chain of survival. We must not eliminate any of the links that form Seattle and King County's life-saving emergency medical response system. Our community's health and safety depends on it.

Alonzo Plough is director of the Seattle-King County Department of Public Health.